Article Text

Review: High-dose inhaled corticosteroids increase the risk for some systemic adverse effects in asthma

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Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy. A systematic review and meta-analysis. Arch Intern Med. 1999 May 10; 159:941-55.


In patients with asthma, what are the systemic adverse effects of inhaled cor-ticosteroids (ICs)?

Data sources

Studies were identified by searching MEDLINE, EMBASE/Excerpta Medica, and BIDS (1966 to July 1998) with 30 key terms and by scanning scientific abstracts in key respiratory and allergy journals and bibliographies.

Study selection

Studies were selected if they provided sufficient data on patients, study design, quality, route of drug administration, end points, and analysis.

Data extraction

Data were extracted on patients; study design; drugs; end points; time of measurement; and outcomes for adrenal suppression, growth, bone density, and ocular and skin effects.

Main results

Adrenal suppression: 10 randomized, single- or double-blind, controlled trials (RCTs) evaluated 3 doses of ICs in adults (8 RCTs) and children (2 RCTs) with asthma. Adrenal cortisol suppression was shown in 7 of 8 RCTs on fluticasone (range 9% to 78%), 1 of 5 RCTs on budesonide (14% to 46%, depending on the …

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